Abstract

While spirituality has increasingly been recognized as a vital component of holistic health, the scientific measurement of its neurobiological underpinnings remains underdeveloped. This study aims to test the construct validity of an innovative instrument measuring both Conventional Executive Function (CEF) and Transcendental Executive Function (TEF) using Confirmatory Factor Analysis (CFA). Data were collected from 795 ethnically and religiously diverse participants across five Indonesian cities. Results revealed strong construct validity, with 88% of items demonstrating adequate factor loadings (≥0.4). The TEF dimensions had better measurement qualities, showing excellent fit with the model (RMSEA=0.020, CFI=0.999, TLI=0.999, SRMR=0.010) than the CEF dimensions. The Transcendence (0.315-0.925), Decision Making (0.642-0.857), and Meaning of Life (0.596-0.948) dimensions showed very strong relationships, which supports the idea that spiritual and transcendent thinking is linked to measurable brain activity.  These findings question the usual separation between rationality and spirituality, indicating that both are connected parts of how the brain works, which affects mental health treatments, psychospiritual evaluations, and our understanding of the connections between mind, brain, and spirit.

Introduction

The relationship between spirituality and health outcomes has been increasingly documented in scientific literature ; with numerous studies revealing positive associations between spiritual well-being and mental health , physical health, and overall quality of life. At the same time, new findings in neuroscience are starting to show how spiritual experiences are connected to brain activity, indicating that what we used to think of as just spiritual might actually have clear biological links in the brain. Despite these parallel developments, there remains a significant gap in understanding how spirituality integrates with executive brain functions and how this integration might influence health outcomes Charles, in an article by Rosmarin, asserts that the significance of spirituality and religion in mental health and mental health care has led to the establishment of guidelines for psychiatrists about the integration of spirituality and religion into psychiatric therapy.

Traditional approaches to neuroscience have largely operated within a materialistic framework that tends to relegate spirituality to philosophical or theological domains, divorced from "legitimate" neurocognitive investigation This artificial separation has hindered our understanding of how spiritual experiences and capacities might be interwoven with key brain functions that regulate cognition, emotion, and behavior. Executive function—traditionally associated with cognitive control, self-regulation, and decision-making—has rarely been examined in relation to spiritual experience and practice, despite emerging evidence suggesting significant overlap in their neural substrates.

Recent brain imaging studies have shown that spiritual and religious experiences light up areas of the brain linked to decision-making and self-control, such as the prefrontal cortex, anterior cingulate cortex, and insular cortex . Meditative states, thinking about right and wrong, and deep personal reflection seem to use brain pathways that are very similar to those used in regular thinking and decision-making. These findings challenge the longstanding dichotomy between "rational" and "spiritual" processes, suggesting instead that spirituality may operate as an extended dimension of executive function with measurable neurobiological correlates.

The conventional understanding of executive function (CEF) encompasses cognitive processes such as working memory, inhibitory control, cognitive flexibility, and attention regulation, primarily localized in the prefrontal cortex but involving distributed networks including the limbic system, basal ganglia, cingulate cortex, and temporal regions . We propose expanding this framework to incorporate what we term Transcendental Executive Function (TEF), defined as "an advanced neural system of brain executive function that integrates belief systems to generate transcendent experiences, value-based decisions, positive emotion regulation, life meaning construction, and ritual implementation, regulated by complex neural networks in the brain" .

Fundamentally, CEF operates through goal-directed cognitive control mechanisms for basic behavioral regulation, whereas TEF extends beyond conventional cognition to include higher-order meaning-making processes that integrate the spiritual dimension with executive neural networks. This bidirectional relationship suggests that conventional executive functions can influence transcendental capacities, and conversely, spiritual practices can enhance cognitive control abilities through the same neural substrate. This distinction is critical as it positions spirituality not as a separate entity from executive functioning, but rather as an integrated dimension that expands our understanding of how transcendent values, beliefs and experiences contribute to decision-making and control of human behavior.

This conceptualization offers several advantages over traditional approaches to spirituality measurement. First, it operationalizes spirituality in neurobiological terms, making it accessible to empirical investigation. Second, it acknowledges the multidimensional nature of spiritual experience, encompassing transcendence, values-based decision-making, emotion regulation, meaning-making, and ritual practice. Third, it bridges the gap between scientific materialism and spiritual experience by suggesting that spirituality is neither separate from nor reducible to brain function but rather represents an integrated aspect of neural processing with implications for psychological well-being.

Existing psychometric instruments for measuring spirituality, such as the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACIT-Sp) and the Spiritual Well-Being Scale (SWBS), primarily assess subjective spiritual well-being without addressing its neurobiological foundations. These scales tend to measure spirituality as an isolated construct, disconnected from cognitive functioning and neural processes. The PASH-BRAINS (Psychological Assessment for Spiritual Health and Brain Function Screening) was developed to address this limitation by integrating neuroscientific understanding of executive function with systematic measurement of spiritual capacities.

The potential health implications of understanding the CEF-TEF relationship are substantial. If spirituality operates through neurobiological mechanisms related to executive function, the discovery suggests new possibilities for health interventions that target these pathways. Patients with disorders affecting executive function (e.g., depression, anxiety, PTSD) might benefit from interventions that strengthen TEF capacities. Likewise, spiritual practices might be more precisely tailored to support executive functioning in clinical populations.

This study aims to confirm that the PASH-BRAINS instrument accurately measures what it is supposed to by analysing the factor structure of both CEF and TEF dimensions. By confirming the reliability of this tool, we want to give researchers and healthcare providers a dependable way to measure how executive function and spirituality work together, which could be useful in health evaluations, creating interventions, and improving our understanding of the connections between the mind, brain, and spirit.

The conceptualization of TEF as an executive function has a strong neuroscientific basis. Neuroimaging studies show that meditation results in activation of the prefrontal cortex, activation of the thalamus and inhibitory thalamic nucleus reticularis, as well as functional deafferentation of the parietal lobe . Neuroimaging techniques o3f fMRI, PET and SPECT have successfully identified specific neurobiological changes during spiritual practice, including changes in cerebral blood flow and neurotransmitter activity in the same brain structures that regulate conventional executive function . This converging evidence supports that spiritual-transcendent capacities such as meaning-making and value-based decision-making operate through executive neural networks, justifying their conceptualization as transcendental executive functions.

Methods

Data were collected from 754 participants between November and December 2024 using an online survey hosted at pashbrains.com. The sample represented diverse backgrounds across five Indonesian cities: Manado, Jakarta, Palangkaraya, Surabaya, and Karawang. Participants included university students, teachers, government employees, and hospital residents. This diversity is particularly valuable for a study examining spirituality, as it captures varied religious and cultural perspectives on spiritual experience.

Demographic information collected included age, sex, and religious affiliation. The sample included participants across the adult lifespan, with 39.8% aged 16-25, 33.0% aged 26-35, 17.4% aged 36-45, 8.5% aged 46-55, and 1.3% aged 56-65. The gender distribution showed 58.4% female and 41.6% male participants. Regarding religious affiliation, the sample reflected Indonesia's religious diversity, with Muslims comprising the majority (75.0%), followed by Christians (16.8%), Catholics (5.3%), Buddhists (1.6%), Hindus (0.4%), Confucians (0.4%), and others (0.4%). This religious diversity is particularly important for a study of spiritual constructs, as it helps ensure that the instrument captures spirituality across different religious frameworks rather than being limited to a single tradition's conceptualization. Table 1 provides a detailed breakdown of demographic characteristics.

Table 1 is here

The validation study of PASH BRAINS (Psychological Assessment for Spiritual Health and Brain Function Screening) showed strong results using Confirmatory Factor Analysis (CFA) on 795 participants from various backgrounds in Indonesia. - 88% of the 75 items showed significant factor loading (≥0.4). The Transcendental Executive Function (TEF) dimension showed superior psychometric properties with excellent model fit indices (RMSEA=0.020, CFI=0.999, TLI=0.999, SRMR=0.010). The highest factor loadings were found in the Transcendence (0.315-0.925), Decision Making (0.642-0.857), and Meaning of Life (0.596-0.948) dimensions. Comparison of CEF and TEF: TEF dimensions showed higher average loadings (0.662 vs. 0.609) and better model fit indices than CEF dimensions. The Decision Making and Meaning of Life dimensions had the strongest psychometric properties with mean loadings of 0.725 and 0.733, respectively. Implications: The validation results support the concept of integration between the executive functions of the brain and the spiritual dimension. The findings challenge the traditional dichotomy between rationality and spirituality, suggesting both are integrated aspects of brain functioning The instrument has the potential to be a valuable tool for comprehensive mental health assessment, intervention, and a deeper understanding of the brain-mind-spirituality connection.

This study was conducted in accordance with the principles of the Declaration of Helsinki and established research ethics guidelines to ensure the protection and welfare of all participants. As a supervising researcher in two related studies, the author has access and authority to the data that has been collected based on ethical approval from the RESEARCH ETHICS COMMISSION of the NATIONAL UNIVERSITY “VETERAN” JAKARTA with approval numbers: 383/IX/2024/KEP and 402/X/2024/KEP. Prior to data collection, the Indonesian Brain School was given a comprehensive explanation of the research objectives, methodology, and data utilization plan for academic purposes and scientific publications. Based on this explanation, the authors have obtained formal permission from Sekolah Otak Indonesia for access and use of their data through a letter numbered 71/YSOI-PSP/I/2025 with the subject “Explanation Before Consent”. The analysis in this article is a secondary analysis of a dataset that has been collected from 739 participants in collaboration with the Indonesian Brain School. As the supervising researcher listed in the ethical protocol, the author has the responsibility and authority to conduct further analysis of the data that has been collected in accordance with the approved research objectives. All participants provided informed consent with the understanding that their data would be used for academic research purposes. Confidentiality and anonymity were strictly maintained throughout the research process, and all personal data was stored securely and could only be accessed by the authorized research team in accordance with established data security protocols.

The PASH-BRAINS (Psychological Assessment for Spiritual Health and Brain Function Screening) is a self-report assessment tool consisting of 75 items measured on a 5-point Likert scale. The instrument is divided into two main sections as outlined in Table 2

Table 2 is here

This structure shows how traditional ideas about executive function in the brain connect with aspects of spiritual experiences that might have biological links. The instrument was developed through extensive literature review, expert consultation, and preliminary psychometric testing.

We conducted Confirmatory Factor Analysis (CFA) to test the hypothesized factor structure of the PASH-BRAINS instrument and assess its construct validity. We employed maximum likelihood estimation with the following fit criteria:A Factor Loading of 0.4 or higher was seen as good; a t-statistic greater than 1.96 showed that the results were statistically significant (p < 0.05); a Construct Reliability (CR) above 0.70 indicated strong internal consistency; and an Average Variance Extracted (AVE) over 0.50 suggested good convergent validity.To check how well the model fits, we used common measures like Chi-square, root mean square error of approximation (RMSEA), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and standardized root mean square residual (SRMR). According to standard rules, we looked for RMSEA to be less than 0.08, CFI and TLI to be greater than 0.95, and SRMR to be less than 0.08 as signs of a good model fit. Following conventional guidelines, we considered RMSEA < 0.08, CFI/TLI > 0.95, and SRMR < 0.08 as indicators of excellent model fit.We used a repeated uni-factor model approach, loading questionnaire items on each factor independently. We chose this approach due to its simplicity and interpretability, which enables a clearer evaluation of individual constructs. To identify the ordinal CFA model, we freed the factor loadings of each item and set the variance of each factor to 1. We conducted all analyses using the lavaan package in R statistical software.This analytical approach allowed us to examine the factor structure of both CEF and TEF dimensions, evaluate the adequacy of individual items, and compare the psychometric properties of the two major components of the PASH-BRAINS instrument.

Result and discussion

Factor Loadings and Model Fit

The CFA revealed significant factor loadings (≥0.4) for 66 of the 75 items (88%), indicating strong overall construct validity. Within the CEF domain, 45 of 50 items (90%) demonstrated adequate loadings, while the TEF domain showed 21 of 25 items (84%) meeting the threshold. Particularly strong loadings were observed in the Transcendence dimension (0.315-0.925), Decision Making dimension (0.642-0.857), and Meaning of Life dimension (0.596-0.948). Complete factor loadings for all 75 items are available as supplementary material upon request. The model fit indices showed excellent fits for all dimensions, as presented in Figure 1 and 2. All CEF dimensions demonstrated good fit, with RMSEA values ranging from 0.040 to 0.048, CFI values from 0.979 to 0.989, TLI values from 0.966 to 0.982, and SRMR values from 0.021 to 0.037. The TEF dimensions showed even stronger fit indices, with RMSEA values ranging from 0.000 to 0.036, CFI values uniformly at or approaching 1.000, TLI values from 0.995 to 1.006, and SRMR values from 0.004 to 0.012.

Figure 1.Model Fit Indices for CEF DimensionsNote. RMSEA = Root Mean Square Error of Approximation; CFI = Comparative Fit Index; TLI = Tucker-Lewis Index; SRMR = Standardized Root Mean Square Residual.

Figure 2.Model Fit Indices for TEF DimensionsNote. RMSEA = Root Mean Square Error of Approximation; CFI = Comparative Fit Index; TLI = Tucker-Lewis Index; SRMR = Standardized Root Mean Square Residual.

A key finding was that the figure 2 showed better fit scores than the CEF dimensions (Figure 1), with an average RMSEA of 0.020 (compared to 0.045 for CEF), average CFI of 0.999 (compared to 0.985), average TLI of 0.999 (compared to 0.975), and average SRMR of 0.010 (compared to 0.029). This evidence suggests that the TEF measurement model demonstrates superior coherence and validity compared to the CEF model, despite having a slightly lower percentage of items with adequate loadings. Figure 1 revealed varying psychometric strengths, as detailed in Figure 3. The Cingulate Cortex dimension showed the strongest properties, with an average loading of 0.691 and no items below the 0.4 threshold. The Basal Ganglia and Temporal Lobe dimensions also performed well, with average loadings of 0.633 and 0.619, respectively, and no items below the threshold.

Figure 3.Summary of Factor Loadings for CEF Dimensions

Figure 3 showed the weakest properties, with three items (Scores 1, 2, and 3) falling below the 0.4 threshold, with the lowest loading at 0.080. Similarly, the Limbic System dimension had two items (Scores 14 and 16) below the threshold, with loadings of 0.384 and 0.302. Despite these lower-performing items, the overall CEF structure demonstrated good construct validity, with 90% of items showing adequate loadings. TEF Dimensions Analysis Among the TEF dimensions, Decision Making and Meaning of Life showed the strongest psychometric properties, with average loadings of 0.725 and 0.733, respectively, and no items below the 0.4 threshold, as shown in Figure 4. These dimensions also showed the highest maximum loadings (0.857 and 0.948), suggesting they are particularly robust aspects of the TEF construct.

Figure 4.Summary of Factor Loadings for TEF Dimensions

The Transcendence, Positive Emotion, and Ritual dimensions each had items falling below the 0.4 threshold: Score_55 (0.315) in Transcendence, Score_62 (0.335) in Positive Emotion, and Scores 71 and 72 (0.344 and 0.372) in Ritual. Even though these items scored lower, the TEF dimensions as a whole still showed great fit indices, indicating that the valid items effectively measure transcendental executive functioning in a clear and meaningful way. Compare CEF and TEF dimensionsComparative analysis of the CEF and TEF dimensions revealed intriguing differences in their psychometric properties, summarized in Figure 5. The TEF dimensions showed higher average factor loadings (0.662 vs. 0.609), higher minimum loadings (0.315 vs. 0.080), and higher maximum loadings (0.978 vs. 0.854) compared to CEF dimensions. TEF dimensions also demonstrated consistently better fit indices across all measures (RMSEA, CFI, TLI, and SRMR).

Figure 5.Comparison of CEF and TEF Psychometric PropertiesNote. CEF = Conventional Executive Function; TEF = Transcendental Executive Function; RMSEA = Root Mean Square Error of Approximation; CFI = Comparative Fit Index; TLI = Tucker-Lewis Index; SRMR = Standardized Root Mean Square Residual.

However, TEF had a slightly higher percentage of items with loadings below 0.40 (16% vs. 10%), reflecting the difference in the total number of items in each category (25 vs. 50). This result suggests that while the overall TEF construct shows stronger coherence and validity, there may be more variability in how individual TEF items perform, particularly in the Ritual dimension.

The strong overall construct validity of the PASH-BRAINS instrument (88% of items with adequate loadings) provides empirical support for conceptualizing spirituality as an integrated aspect of executive brain function rather than as a separate or purely subjective phenomenon. This finding challenges the traditional dichotomy between "rational" brain processes and "spiritual" experiences, suggesting instead that spirituality may operate through identifiable neural networks that can be systematically measured alongside conventional executive functions.

The excellent fit indices for all dimensions indicate that the hypothesized factor structure of both CEF and TEF aligns well with the observed data. This supports the theoretical framework underlying PASH-BRAINS, which posits that executive function encompasses both conventional cognitive processes and transcendental capacities. The significant factor loadings on most items suggest that the instrument successfully captures the intended constructs, providing a reliable and valid measure of the integration between brain function and spirituality.

From a health perspective, these findings are particularly relevant because they suggest that spiritual capacities may have measurable neurobiological correlates that influence cognitive functioning. Given the established relationship between executive function and various health outcomes—including mental health disorders, cognitive decline, and rehabilitation outcomes—understanding how spirituality interfaces with these functions could open new avenues for health assessment and intervention. For instance, strengthening TEF capacities might potentially support executive functioning in individuals with conditions affecting prefrontal cortex function, such as depression, PTSD, or traumatic brain injury.

Comparative Analysis of CEF and TEF: Implications for Mind-Brain-Spirit Relationship

The finding that TEF dimensions demonstrated superior psychometric properties compared to CEF dimensions—with higher average loadings and better fit indices—is particularly noteworthy. This suggests that contrary to the assumption that spiritual constructs would be more difficult to measure reliably than conventional cognitive constructs, the spiritual-transcendent dimensions actually showed greater coherence and measurement precision.

One possible interpretation is that spiritual-transcendent capacities like meaning-making, value-based decision-making, and transcendent experience may represent more integrated neural functions that draw on multiple brain regions working in concert. Recent neuroscientific research supports this interpretation, showing that spiritual practices and experiences typically engage distributed neural networks rather than isolated regions . The default mode network (DMN), salience network (SN), and central executive network (CEN) have been shown to work in coordinated patterns during spiritual and meditative experiences , potentially explaining the stronger coherence of TEF measurements. This has important implications for our understanding of the mind-brain-spirit relationship. Rather than viewing spirituality as epiphenomenal to brain function or as entirely separate from it, these findings suggest spirituality may represent an emergent property of integrated neural networks—a higher-order cognitive function that arises from but is not reducible to underlying neural processes. This perspective aligns with contemporary philosophical approaches to consciousness that reject both strict reductionism and dualism in favor of emergent or non-reductive physicalist accounts.

From a health perspective, the stronger coherence of TEF dimensions suggests that spiritual-transcendent capacities like meaning-making and value-based decision-making may serve as particularly robust resources for maintaining psychological well-being. The Decision Making and Meaning of Life dimensions showed the strongest psychometric properties among all dimensions (both CEF and TEF), suggesting these aspects of spiritual functioning may be especially important targets for health interventions

Analysis of Lower-Performing Items: Complexity of Neural-Spiritual Integration

The identification of nine items with loading factors below the 0.40 threshold—five from CEF and four from TEF—provides valuable insights into the complexities of measuring integrated brain-spirit functioning. From a psychometric perspective, these lower loadings may indicate constructs that are more multidimensional or complex than can be captured through a single factor.

The concentration of lower-performing items in the Prefrontal Cortex (PFC) dimension is particularly interesting. The PFC is involved in numerous higher-order cognitive functions, including abstract reasoning, planning, and decision-making. The lower loadings on items 1-3 may reflect the complexity of prefrontal function and its variable relationship with spiritual capacities. Some aspects of prefrontal functioning (e.g., abstract conceptual thinking) may have less direct connection to spiritual experience than others (e.g., self-regulation), potentially explaining these lower loadings.

Similarly, the lower loadings on two items in the Limbic System dimension may reflect the heterogeneity of emotional processing in relation to spiritual experience. While research has shown limbic activation during spiritual experiences, the specific patterns of emotional engagement may vary considerably across individuals and traditions, potentially contributing to lower loadings on certain items.

Within the TEF dimensions, the lower loadings on items in the Ritual dimension may reflect the culturally variable nature of spiritual practices. Ritual practices vary substantially across religious and spiritual traditions, potentially leading to greater heterogeneity in responses compared to more universal aspects of spiritual experience like meaning-making or transcendence. This variability might explain why two of the five Ritual items showed loadings below threshold.

The variability in TEF item performance likely reflects the complexity of spiritual constructs that vary across religious traditions in the Indonesian sample. Items with low loadings on the Ritual and Transcendence dimensions require refinement to improve conceptual clarity. The next iteration of the instrument will consider item reformulation and validation across religious groups.

Clinical and Health Implications

The validation of PASH-BRAINS has significant implications for clinical practice and health promotion. By providing a reliable and valid measure of integrated brain-spirit functioning, this instrument offers several potential applications:

1. Enhanced Assessment: The PASH-BRAINS instrument could supplement traditional neuropsychological assessment by capturing spiritual-transcendent aspects of executive function that are typically overlooked. This might provide a more comprehensive understanding of cognitive functioning, particularly relevant for patients from cultural backgrounds where spirituality is centrally important.
2. Targeted Interventions: Understanding which aspects of transcendental executive function show strongest properties (e.g., meaning-making, value-based decision-making) could guide the development of interventions that specifically target these capacities. For instance, meaning-centered psychotherapy might be particularly effective for strengthening TEF in patients with conditions affecting executive function.
3. Holistic Rehabilitation: In neurological rehabilitation settings, assessment of both CEF and TEF could inform more holistic approaches to cognitive recovery. Spiritual practices that engage value-based decision-making or meaning construction might complement traditional cognitive rehabilitation techniques.
4. Cultural Competence: The strong psychometric properties of the PASH-BRAINS instrument across a religiously diverse sample suggest it may be useful for culturally sensitive health assessment. This is particularly important given growing recognition of the need for culturally competent approaches to mental health care that acknowledge the role of spirituality in many cultural contexts.
5. Preventive Health: The strong relationship between TEF dimensions and executive functioning suggests potential applications in preventive health. Practices that strengthen spiritual-transcendent capacities might potentially support executive function resilience, which has implications for cognitive aging and prevention of executive dysfunction.

The validation of PASH-BRAINS opens up potential future clinical applications. As an illustration, TEF dimensions such as Meaning of Life that have strong psychometric properties can inform the development of meaning-centered therapy interventions for patients with executive dysfunction. Further research is needed to test the clinical effectiveness of this framework in real therapeutic settings.

Limitations and Future Directions

While this study provides strong support for the validity of the PASH-BRAINS instrument, several limitations should be acknowledged. First, CFA methodology, while appropriate for testing hypothesized factor structures, limits exploration of alternative models that might better represent the data. Future research could employ Exploratory Structural Equation Modeling (ESEM) to investigate potential cross-loadings and more complex relationships between items and factors. Second, the current study relies on self-report measures, which may be subject to social desirability and recall biases. Future validation could incorporate behavioral tasks measuring executive function or neuroimaging methods to establish convergent validity with neural activity patterns during spiritual practices. Third, while our sample was diverse in terms of age, gender, and religious affiliation, it was limited to the Indonesian context. Cross-cultural validation would be valuable to determine whether the factor structure remains consistent across different cultural and religious contexts.

The claims of neurobiological correlations in this study are based on the theoretical foundation of previous neuroimaging studies showing prefrontal cortex activation during spiritual practices, rather than direct neurobiological measurements. Further research with fMRI and EEG is needed to empirically validate the neurobiological relationships postulated in this TEF framework, as the majority of S/R neurobiological research requires more validated assessments.

Another limitation is that Indonesia's predominantly religious context may limit generalizability to Western secular societies. The PASH-BRAINS framework requires cross-cultural adaptation and validation to ensure universal applicability, given that spirituality is expressed differently in diverse cultural contexts.

Additionally, Indonesia's collectivist and religious cultural context is likely to influence the interpretation of TEF items, particularly the Ritual Practice and Meaning of Life dimensions that emphasize spiritual communality. The dimensions of individualism-collectivism, religiosity orientation, and cultural values such as gotong royong may influence the cross-cultural expression of the TEF. International validation requires adaptation of items that are sensitive to specific cultural orientations.

Future research directions include:

1. Longitudinal Studies: Investigating how the relationship between CEF and TEF changes over time, particularly in response to health challenges or spiritual practices.
2. Clinical Applications: Testing the utility of PASH-BRAINS in clinical populations, such as patients with depression, anxiety, PTSD, or neurodegenerative conditions affecting executive function.
3. Neuroimaging Validation: Using fMRI or EEG to examine the neural correlates of high vs. low scores on TEF dimensions, potentially confirming the hypothesized relationship between spiritual capacities and integrated neural networks.
4. Intervention Studies: Developing and testing interventions specifically designed to strengthen TEF capacities, examining their effects on both spiritual well-being and conventional executive functioning.
5. Cultural Adaptation: Adapting and validating the PASH-BRAINS instrument across diverse cultural and religious contexts to ensure its broad applicability.

Conclusion

This study provides robust psychometric validation for the PASH-BRAINS instrument, reinforcing the conceptualization of spirituality as an integrated component of executive brain function. The strong construct validity—demonstrated by 88% of items with adequate loadings—and excellent fit indices across all dimensions indicate that both conventional and transcendental aspects of executive function can be reliably assessed within a unified framework.

The superior psychometric properties of the Transcendental Executive Function (TEF) dimensions compared to the Conventional Executive Function (CEF) dimensions challenge traditional assumptions regarding the measurability of spiritual constructs. This suggests that spiritual-transcendent capacities may represent coherent and integrated aspects of neural functioning. These findings have significant implications for our understanding of the mind-brain-spirit relationship, indicating that spirituality may emerge from integrated neural networks rather than being merely reducible to—or separate from—brain function.

From a health perspective, these results open new possibilities for assessment and intervention. By identifying the neurobiological correlates of spiritual capacities, clinicians and researchers can develop more comprehensive approaches to supporting executive function in both health and illness. Notably, the strong psychometric properties of the Meaning of Life and Decision-Making dimensions suggest that these aspects of spiritual functioning may serve as particularly valuable targets for health interventions.

The PASH-BRAINS instrument marks a significant advancement in the measurement of spirituality within a neuroscientific framework. By bridging the historical divide between brain science and spiritual experience, this approach provides a more integrated understanding of human cognition—one that recognizes transcendent capacities as fundamental aspects of neural architecture rather than incidental epiphenomena. This integration carries profound implications for healthcare, offering the potential for more holistic approaches that address human functioning across physical, cognitive, emotional, and spiritual dimensions. While this study provides strong support for the validity of the PASH-BRAINS instrument, several limitations must be acknowledged. First, the Confirmatory Factor Analysis (CFA) methodology—though suitable for testing hypothesized factor structures—restricts the exploration of alternative models that might better fit the data. Future research could employ Exploratory Structural Equation Modeling (ESEM) to examine potential cross-loadings and more intricate relationships between items and factors.

Second, this study relies on self-report measures, which may be influenced by social desirability and recall biases. Future validation efforts could integrate behavioral tasks that assess executive function alongside neuroimaging methods, allowing researchers to establish convergent validity between neural activity patterns and spiritual practices. And , while the sample included diversity in age, gender, and religious affiliation, it was confined to the Indonesian context. To determine whether the factor structure remains consistent across different cultural and religious backgrounds, future studies should conduct cross-cultural validation with broader and more diverse populations.

Acknowledgement

This research was funded by the Sam Ratulangi University and UPN “ Veteran” Jakarta. We would like to express our sincere gratitude to the Faculty of Medicine, Sam Ratulangi University, and the Faculty of Medicine, Universitas Pembangunan Nasional Veteran Jakarta for their invaluable support in the completion of this research.

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